• Smile in Style Child Dental Benefits

    Please note that it is important to fill in all the fields before submitting. Thank you.
  • Child Dental Benefits Schedule Bulk Billing Patient Consent Form

  • I, certify that I have been informed:
    - of the treatment that has been or will be provided from this date under the Child Dental Benefits Schedule; of the likely cost of this treatment; and that I will be bulk billed for services under the Child Dental Benefits Schedule and I will not pay out-of-pocket costs for these services, subject to sufficient funds being available under the benefit cap.

  • form is valid up to 31 December of the calendar year for which it is signed

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